National Board of Revenue
www.nbr.gov.bd IT-11Gha 2023
For office use
Serial no. in return register Return of Income
Column no. in return register
For Company as per sec. 2(31) difine Income tax act, 2023
Date of return submission
1 Name of the Assessee: HI-Life International Ltd.
2 TIN: 3 9 6 9 2 7 3 1 9 6 2 9
3 Business Identification Number (BIN): 005356444-0402
4 Document Vefification System(DVS No:) 2312101274AS543329
5 (a) Circle: 134(Company) (b) Tax Zone: 07, Dhaka
6 Type of Return (tick one) : Self ✔ Normal Other
7 Asssessment Year: 2023-2024
8 Closing Date of income year 30-Jun-23
9 Resident Status: Resident ✔ Non-resident
10 Address: 146, Green Road, Dhaka
Telephone: Mobile:
e-mail:
11 Nature of Business: Import , Medical equipment seller, distributor
12 Resident Status: Local ✔ Foreign
13 Incorporation no: C-182775
14 Incorporation Date: 28-Jul-22
15 Submission of Statement against foreign Transacton as per Section 238 Yes No
16 If laible to submission of tatements aginst foreign Transaction attachement with return Yea No
Particulars of Income and Tax during the income year ended on 30-Jun-23
Name of the Assessee: HI-Life International Ltd.
TIN: 3 9 6 9 2 7 3 1 9 6 2 9
Particulars of Total Income Amount ৳
1 Income from Rent -
2 Agricultural income -
3 Income from business 1,155,495
4 Capital gains -
5 Income from Financial Assets (Bank interest/profit, Dividend, Securities etc.) -
6 Income from other sources (Royalty, License fee, Honorarium, Fees, Govt. Incentive etc.) -
7 Foreign income -
8 Total income (aggregate of 1 to 7) 1,155,495
Tax Computation Amount ৳
9 Gross tax on taxable Income (1,155,495)
10 Tax rebate -
11 Tax payable after tax rebate (9-10) (1,155,495)
12 Minimum tax 77,640
13 Turnover Tax -
14 Tax Payable (Higher of 11, 12 and 13) 77,640
15 Delay Interest, Penalty or any other amount under the Income Tax Act (if any) -
16 Total amount payable (14+15) 77,640
Particulars of Tax Payment Amount ৳
17 Tax deducted or collected at source (attach proof) -
18 Advance tax paid (attach proof) -
19 Adjustment of tax refund [mention assessment year(s) of refund] -
20 Amount paid with return (attach proof) 77,640
21 Total amount paid and adjusted (17+18+19+20) 77,640
22 Deficit or excess -
PART III
Particulars of Tax Benefits
Name of Taxpayer Company: HI-Life International Ltd.
TIN
A. Income enjoying tax exemption (provide additional paper if necessary)
Source Section SRO Amount ৳
SL
1
2
3
4
B. Income enjoying reduced tax rate (s) (provide additional paper if necessary)
SL Source Section SRO Amount ৳
1
2
3
4
C. Amount of tax benefits enjoyed As per above A & B Amount ৳
SL Source Amount ৳
1 Tax payable if not applicable above A & B
2 Tax payable if applicable above A & B
3 Tax benefit enjoyed as per above A & B (1-2)
4 Amount of Tax benefit
PART V
Other Particulars
Name of Tax payer: HI-Life International Ltd.
TIN
A. Particulars of bank accounts (provide additional paper if more names)
Name of bank(s) Account number(s) Branch name (if applicable)
SL
1 United Commercial Bank PLC 0832101000021788 Uttara Branch
2
3
B. Particulars of directors (provide additional paper if more names)
No of % of share in paid-
SL Name of director(s) TIN Amoutn of Tk.
shares up capital
1 Nasrin Akter 148890223183 9,800 98% 980,000
2 Md. Sajjad Hossain Sajib 625697561939 200 2% 20,000
3
4 Total 10,000 100% 1,000,000
C. Particulars of affiliated entities (provide additional paper if more names)
SL Name (s) of affiliated entity TIN Type (company, firm etc.)
1
2
3
4
Name of the Assessee: HI-Life International Ltd.
TIN: 3 9 6 9 2 7 3 1 9 6 2 9
Amount of Tk.
SL Summary of Income Current year Previous year
1 Sale/Turnover/Receipts 1,582,580
2 VAT(if any) -
3 Net Sales/turnover/ Receipts (1-2) 1,582,580 -
4 Cost of Goods Sold 1,263,465
5 Gross Profit (3-4) 319,115 -
6 General, Administrative, Selling and Other expenses 1,471,784
7 Selling & Marketing expense
8 Interest and others expenses 2,826
9 Net profit (5-6-7-8) (1,155,495) -
10 Others income (if any) -
11 Net profit before Tax (1,155,495) -
SL Summary of Balance Sheet Amount ৳ Amount ৳
1 Fixed Assets(Property,Plant & Equipment(PP&E) Tangible 267,100
2 Intangible assets
3 Financial assets
4 Current assets
5 Advance, deposit & prepayments 52,000
6 Inventory 450,248
7 Cash & Cash equivelent 2,327,295
8 Other Assets
9 Total Assets (sum of 1 to 8) 3,096,643 -
10 Paid up Capital 1,000,000
11 Reserve/Surplus
12 Retained earnings (1,164,991)
13 Provission for expenses 77,640
14 Institutional Liabilities
15 Non-institutional Liabilities 3,252,138
16 Total Equities & Liabilities 3,096,643 -
People's Republic of Bangladesh
National Board of Revenue
(Income Tax Office)
www.nbr.gov.bd
Acknowledgement Receipt/ Certificate of Return Of Income
Assessment Year: 2023-2024
Name of the Assessee: HI-Life International Ltd.
National Identification Number/Passport Number (If no NID): 005356444-0402
TIN: 3 9 6 9 2 7 3 1 9 6 2 9
Circle : 134(Company) Tax Zone : 07, Dhaka
Total income shown ৳ 1,155,495
Total tax paid ৳ 9,495
Serial no. in return register
Volumn no. in return register
Date of return submission
Seal of Tax Office Signature and seal of the official receiving the return
Name of the Assessee: HI-Life International Ltd.
TIN: 3 7 3 3 7 5 2 7 8 9 0 4
List of documents furnished with this Return
1 Tax computation sheet 10 Copy of Tax challan us-173 tk. 9495
2 Incorporation certificate 11
3 MOA & AOA with Form-xii 12
4 Trade licenses with rent deed 13
5 Bank statements 14
6 Salary statements 15
7 Fixed assete addition invoice 16
8 TIN & BIN 17
9 TDS Challan audit fees+ rent+ Purchase
Verification
I, HI-Life International Ltd.
solemnly declare that to the best of my knowledge and belief the information given in this return
A)
and statements and documents annexed or attached herewith are correct and complete.
Signed and certified by me as Chief Executive/Chief Officer as per Section 2(54) of the Income
B)
Tax Act, 2023.
......................................................
Place: Signature
Date: HI-Life International Ltd.
Designatiom & Seal (for other than individual)
Intruction to fill up the return form
Instructions:
(1) This return of income shall be signed and verified by the respective person as prescribed u/s
169(5) ka of the Income Tax Act, 2023.
(2) Submitted audited report As per Section 73 of income tax Act, 2023
(3) Enclose where applicable:
(a) Salary statement for salary income; Bank statement for interest/profit; Certificate for
interest on savings instruments; Rent agreement, receipts of municipal tax and land
revenue, statement of house property loan interest, insurance premium for house
property income; Statement of professional income ; Copy of assessment/ income
statement and balance sheet for partnership income; Documents of capital gain;
Dividend warrant for dividend income; Statement of other income; Documents in
support of investments in savings certificates, LIP, DPS, Zakat, stock/share etc.
(b) Statement of income and expenditure; Manufacturing A/C, Trading and Profit & Loss
A/C and Balance sheet;
(c) Depreciation chart claiming depreciation as per SCHEDULE of the Income Tax Act,
2023;
(d) Computation of income according to Income tax act 2023;
(4) Enclose separate statement for:
(a) Any income of the spouse of the assessee (if she/he is not an assessee), minor children
and dependant;
(b) Tax exempted / tax free income as per schedule & S.R.O of ITA, 2023.
(c) Tax exempted /tax free income as per Six schedule part-1 of ITA, 2023
(d) Tax exempted income as per income tax act, 2023
(5) Documents furnished to support the declaration should be signed by the assessee or his/her
authorized representative as per Section 327 of ITA, 2023.
(6) Signature is mandatory for all the assessee or his/her authorized representative.
(7) Submitted Statement of Foreign Transaction (if any) as per section 238 of ITA, 2023
(8) If needed, please use separate sheet.
